Video-guided versus direct laryngoscopy: considerations for using simulation to teach inexperienced medical students

The goal of this study was to determine whether video laryngoscopy (VL) provides any advantage over direct laryngoscopy (DL) in first-attempt intubations. This was a controlled, randomized study of 120 medical students. Students were randomly assigned to either of 2 intubation groups, which used (1) DL (n=64) or (2) VL (n=56) with the Karl Storz C-MAC® video laryngoscope. Each student attempted 1 endotracheal intubation on a Laerdal® Airway Management Trainer. The primary outcome measure was the time for successful endotracheal intubation. Secondary outcome measures included the incidence of esophageal intubation (EI), excess application of pressure on the maxillary incisor teeth (EMP), and first-time success rate. Mean time for endotracheal intubation was significantly faster in the VL group than in the DL group (101 ± 83 seconds vs. 180 ± 102.5 seconds; P˂0.001). In the VL group, 3.6% of the students committed an EI versus 56.3% in the DL group (P˂0.001). No significant difference was found in the incidence of EMP: 51.8% in the VL group versus 57.8% in the DL group (P=0.508). For medical students with little or no endotracheal intubation experience, VL facilitates success and decreases the number of EIs, at least in a simulated environment.